Megaesophagus is a condition where the esophagus enlarges due to abnormal or absent peristalsis. It can be caused by achalasia, myasthenia gravis, esophageal scarring, tumors, hypothyroidism, and Addison’s disease. Diagnosis involves x-rays and treatment includes diet modification, medication, and sometimes feeding tubes. Aspiration pneumonia can also occur and requires hospitalization and antibiotics.
Megaesophagus is a disease of the esophagus in which the organ enlarges due to failure of peristalsis. It occurs not only in humans, but also in cats and dogs. In a normal esophagus, peristalsis occurs through synchronized movement of the esophageal muscle. When peristalsis is abnormal or absent, food cannot get down to the stomach, leading to an enlargement of the esophagus. Treatment of this condition involves targeting the underlying cause, changing the diet, and administering medications that can facilitate motility of the esophagus and stomach.
This condition has several underlying causes. In humans, it can occur due to achalasia. Achalasia is a condition occurring mainly in middle-aged adults in which there is an absence of ganglion cells in the myenteric plexus. This leads to a decrease in peristalsis and an increase in lower esophageal sphincter pressure. The result is dilation or widening of the esophagus. Achalasia is known to predispose patients to esophageal cancer.
In dogs, megaesophagus can be a manifestation of a disease called myasthenia gravis (MG). MG is a neuromuscular disease in which weakness is a primary symptom. In MG, receptors for the neurotransmitter acetylcholine malfunction, leading to impaired conduction of signals from nerves to muscles. With esophageal muscle weakness, megaesophagus occurs.
Megaesophagus can also occur due to esophageal scarring or strictures. These strictures can be the result of swallowing foreign bodies. The presence of tumors in the esophagus can lead to the same condition. Other diseases associated with megaesophagus include hypothyroidism and Addison’s disease.
Diagnosing megaesophagus usually involves x-rays. A simple x-ray is usually done, but a barium study may be necessary in special cases. Endoscopy can be done to view narrowing and tumors. When this condition is radiologically confirmed and symptoms of cough, runny nose, and fever are present, a diagnosis of aspiration pneumonia can be made. Aspiration pneumonia is a serious condition that needs treatment with antibiotics and removal of aspirated material.
Treatment of this condition, whether it occurs in humans or pets, involves diet modification, and sometimes patients do better on liquid diets. It is best to eat your meals in an upright position. Feeding tubes may be required in cases where voluntary feeding is not possible. To address the nausea and regurgitation associated with megaesophagus, a motility-modifying drug called cisapride may be given. If aspiration pneumonia is present, hospitalization may be required, and fluids and antibiotics are usually given.
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